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C Section vs Natural? Caught between docs

Hi all,
I am pregnant with my first child. My crohn's flared a year ago and I was put on stelara and stayed on my imuran. My colonoscopy was really bad with extreme narrowing, but not enough for surgery and I guess the stelara helped. Anyway I am due in 2.5 months, quit the stelara for now, just on imuran. My OB wants a 'not too forceful' vaginal birth, meaning, try for one, but if they needed forceps/vacuum or it got complicated they'd go to a C. I met with my gastro today and he recommended the C. I have some rectal disease, an abscess/fistula i had to have drained many years ago, and some skin tags. I had my terminal ileum removed 7 years ago and a pretty extensive strictureplasty. The OB didn't want to schedule a C for fear of "more scar tissue" but the gastro seems to think there is a good chance I'd tear, and would fear really bad tearing/flaring causing incontinence, which is scary. He also looked at me (5'2 98 lbs pre preg) and my HUGE belly and was just like...seemed to be thinking there's no way that huge baby is getting out of her easily. Seemed like his instinct. He's a top top IBD doc so I trust him, but somehow I was hoping not to have surgery....

any thoughts? pros / cons of a C? I was born via a c section, but I guess I have this vision of a quick not too painful (with an epidural) labor, and now I feel caught between the two docs. The risk of a tear that turns into a fistula does really scare me. I remember how horribly painful my abscess was.

I haven't been flaring during the pregnancy at all, and bowels have been normal/slighly constipated. TIA!
Hi - I don't know if this will help or not...
I haven't had a natural birth, but I can tell you a c-section may not be the worst thing.
I had my son by emergency c-section and it was the easiest part of our journey (4.5 months of hospitalization for him followed).
However, I did have perianal involvement that began after the c-section, so it's certainly no guarantee against that. It may be less traumatic than natural childbirth, IF that is a factor in perianal involvement.
Congratulations on your little one! I haven't had any children yet, but I know coordinating between specialists can be tricky... everyone's focused on a different aspect of your care.

Are your OB and GI talking directly to each other, or just to you? If they aren't talking to each other, I'd request that they do so. IBD is so full of "pros and cons"! If you are having to be a "go between" with your docs that's soooo stressful (I've done it just for general Crohn's complications, not pregnancy, and it's so exhausting!)

Do you have a GP or Internist? My Internist is fabulous when it comes to communicating with all my specialists and getting a "big picture" view of my options.

Anyway, congratulations again!
Thanks for the input. I do know someone else with severe Crohn's who well, wasn't supposed to be pregnant in the first place due to her state, and post c developed fistulas that required months of hospitalization, but I think that's a pretty isolated case. I feel like a normal birth maybe has some benefits for the baby, and that is what the OB is focused on. Frankly I think my health is more important but I am concerned about 'too much' scar tissue if I need more surgery in the future. Also, we would like to have a second child. too many decisions!

I do not have a GP - we just moved so these are the doctors I have for now. The OB & Gastro are at the same hospital, so the OB had written in the system a summary of our chat about natural being preferred, and the Gastro told his fellow to write in bold that he recommends a C.
I would listen to the GI.

Yes the vaginal birth would have some added benefits for baby. There are some ways that you can mitigate that - I've heard of people having c-sections and actually trying to colonize their baby with their own bacteria after birth. There are some other issues that are possible but you can't cover all your bases - you know that from having Crohn's.

Your little one will need you to be as well as you can be. Those early months are joyful and so exhausting!

As far as your size...usually your baby is proportionate. I don't think that should make the decision one way or another.
Hi there. I had anal abscess surgery in 2006 followed by 2 more operations for subsequent fistulas. Based on the risks associated with pushing & delivering naturally it was a no brainer for me to have a planned c-section. Personally, I found a planned c-section to be one of life's best kept secrets! It was so much easier than all the stressful stories about natural delivery I'd heard about, especially the poor ladies who labour on for days & end up having an emergency section once they are exhausted. I walked in on Monday morning, had my little girl, started breast feeding no problem & left the hospital 48 hours later. Yes you have to take it easy & not rush the recovery as it's major abdominal surgery but there was no post natal tiredness that would trigger a flare & no complications in the rectum. For me I'd go for a section every time. Good luck, parenthood is the best adventure ever : )
P.s. Our daughter is extremely healthy, there were no issues with her health whatsoever from a c-section. Hope that helps!


With the history of perianal disease I too would go for a c-section.....I had one on the advice of my ON as I had active fistulas and there was a concern that I could hear or cause more issues with the fistulas. I'm glad I did it, for me it was much easier and I don't see any ill effects with my almost ten year old daughter!